Chemo - neutropenia

[ForAnna]

My dearest friend is now challneged with her 4th recurrenace of Stage III Ovarian cancer.  She had Carboplatin alone in 1999 and was given an 18 month remission.  Her Ca-125 started to rise (not very reliable however) and they found a few cancerous lymph nodes which were removed with more Carboplatin followed by a year of maintenace chemo.  She had another three year remission but it came back with a vengence and we almost lost her to a bowel obstruction and liver mets.  8 rounds of Carboplatin plus Taxotere set it back (last round she developed febril neutropenia [150] - but only for 6 months (August 07) when a CT scan showed it had returned in the bowel.  It was removed - all but a small amount.  Chemo was delayed due to her weight loss (a great deal of lower and upper bowel was removed at the blockage) restricting her abilty to gain weight - the last surgery really made her weak and they would not give her chemo for over 2 months due to that fact.  Last month they tried Carboplatin and Taxotere again but we almost lost her to another febril neutropenic episode  - lower than 100 and it took two weeks to build her back up to 800.  She is so thin and tired but whats to keep fighting.  The doctors told her to go home and enjoy Christmas and that they would talk again in January.  She is afraid they have given up on her as she weighs 85 lbs and spends most of her time resting - even though she can get out abit.  Do you think that one last blast of Chemo could set the cancer back enough giving her time to recoup for another try in Janaury?  Do the other chemos present the same bone marrow depleation problems?  

[janjan19]

I believe that most chemotherapy agents lower the white blood count & may cause neutropenia.  I had taxotere/carboplatin & then topotecan & both rounds of chemo caused this count drop.  For topotecan, I gave myself daily injections of Neupegen after each treatment& that kept the count elevated.

[Annekathryn Goodman, M.D.]

Hi There,
It sounds like your friend has been through so much! It may be that at this point chemotherapy will only harm her. The best measure of how a person will do and what is their prognosis is something called "performance status" It goes like this:

PS = 0 going to work, no symptoms
PS = 1 working, performing all activities of daily living but some minor symptoms, pain, fatigue
PS = 2 not able to work. Able to move around the house, get dressed every day. But more pain and fatigue
PS = 3 not getting dressed most days, gets out of bed but mostly  has to rest for the majority of the day. Very disabled from symptoms
PS = 4 not getting out of bed at all


Your friend sounds like her PS is a 3. With all the high tech tests going around, it may seem surprising how predictive this simple assessment is. But people with a PS of 3 or 4 do not benefit from chemo. It makes much more sense to focus on comfort measures, best supportive care. It is very hard to accept that But actually chemo in this setting can shorten a person's life by the complications of dehydration from diarrhea, vomiting, sepsis from low counts, bleeding from low counts.

take care